Healthcare Provider Details

I. General information

NPI: 1891776233
Provider Name (Legal Business Name): PROLIANCE SURGEONS INC PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 MINOR AVE SUITE 200
SEATTLE WA
98104-2120
US

IV. Provider business mailing address

805 MADISON ST SUITE 901
SEATTLE WA
98104-1172
US

V. Phone/Fax

Practice location:
  • Phone: 206-386-9515
  • Fax: 206-576-3807
Mailing address:
  • Phone: 206-264-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number601484763
License Number StateWA

VIII. Authorized Official

Name: MR. DAVID G FITZGERALD
Title or Position: CEO
Credential:
Phone: 206-838-2599